Provider Demographics
NPI:1336897081
Name:KASS, ALEXANDER JONATHAN (OD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JONATHAN
Last Name:KASS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:JONATHAN
Other - Last Name:KASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2021 W 25TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1965
Mailing Address - Country:US
Mailing Address - Phone:626-223-1817
Mailing Address - Fax:
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-868-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1201X
PAOEG003978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant